Research Findings - Epidemiology and Etiology Research

Prevalence of Marijuana Use Disorders in the United States: 1991-1992 and 2001-2002

Among illicit substance use disorders, marijuana use disorders are the most prevalent in the population. Yet, information about the prevalence of current DSM-IV marijuana use disorders and how prevalence has changed is lacking. To examine changes in the prevalence of marijuana use, abuse and dependence in the United States between 1991-1992 and 2001-2002, face-to-face interviews were conducted in two large national surveys conducted ten years apart: the 1991-1992 National Longitudinal Alcohol Epidemiologic Survey (NLAES: n=42,862), and the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC: n = 43,093). Among the adult U.S. population, the prevalence of marijuana use remained stable at about 4.0% over the past decade. In contrast, the prevalence of DSM-IV marijuana abuse or dependence significantly (p < 0.05) increased between 1991-1992 (1.2%) and 2001-2002 (1.5%), with the greatest increases observed among young Black men and women and young Hispanic men (p < 0.01). Further, marijuana use disorders among marijuana users significantly increased (p < 0.01) in the absence of increased frequency and quantity of marijuana use, suggesting that the concomitant increase in potency of _⁹-THC may have contributed to the rising rates. Despite the stability in the overall prevalence of marijuana use, more adults in the U.S. had a marijuana use disorder in 2001-2002 than in 1991-1992. Increases in the prevalence of marijuana use disorders were most notable among young Black men and women and young Hispanic men. Although rates of marijuana abuse and dependence did not increase among young white men and women, their rates have remained high. The results of this study underscore the need to develop and implement new prevention and intervention programs targeted at youth, particularly minority youth. Compton, W.M., Grant, B.F., Colliver, J.D., Glantz, M.D. and Stinson, F.S. Prevalence of Marijuana Use Disorders in the United States: 1991-1992 and 2001-2002. Journal of the American Medical Association, 291(17), pp. 2114-2121, 2004.

Impact of Childhood Treatment of Anxiety on Later Drug Abuse

This study evaluated outcomes in 86 individuals who had received cognitive behavioral treatment for anxiety disorders in childhood an average of 7.4 years earlier. Based on diagnostic interviews, the authors conclude that a good number of the participants maintained gains in terms of reduced anxiety several years later. They also found that those who responded more positively to the initial treatment had less drug involvement, and fewer drug-related problems, than those who responded less positively. However, this is not a randomized trial, and it is not clear whether the treatment itself was related to the differences in outcome, or whether other characteristics rendered some children at risk for poor outcomes in both arenas. Thus, while this study suggests that treatment of childhood psychiatric conditions holds potential for reducing later drug abuse, further work is needed to confirm this finding. Kendall, P.C., Safford, S., Flannery-Schroeder, E, and Webb, A. Child Anxiety Treatment: Outcomes in Adolescence and Impact on Substance Use and Depression at 7.4-Year Follow-Up. Journal of Consulting and Clinical Psychology, 72, pp. 276-287, 2004.

Cannabis and Other Drugs: Modeling Comorbidity

The authors sought to use a genetically informed approach to explain the comorbidity between cannabis and other drug use. Data from over 2000 same-sex twin pairs were used to test 13 models of comorbidity including versions of the gateway and common risk factor models. For drug use, the correlated liability (common risk factor) model was the best fit, although there may be a subgroup of high-risk cannabis users at increased risk for other drug use (the extreme multiformity of cannabis model). For abuse/dependence, the correlated liability model fit the data best for males; it was difficult to distinguish models for females, probably due to low prevalence of drug abuse. The authors discuss the implications of these findings for prevention: if indeed the use, abuse, and dependence on various drugs is related to common risk factors, then programs that seek to control a specific drug such as cannabis as a "gateway" will not be effective; rather, interventions that focus on common risk factors may be appropriate. Agrawal, A., Neale, M.C., Prescott, C.A., and Kendler, K.S. Cannabis and Other Illicit Drugs: Comorbid Use and Abuse/Dependence in Males and Females. Behavior Genetics, 34, pp. 217-228, 2004.

Personality and Drug Use, Abuse and Dependence

This study used data from a population-based twin registry to assess the genetic and environmental factors contributing to the associations between personality factors and illicit drug use, abuse, and dependence. Based on data from a large sample of same-sex adult twin pairs, the authors found that genetic factors explained much of the relationship between personality and drug abuse. Novelty-seeking related most strongly, particularly for males and particularly for cannabis use. Neuroticism showed the greatest genetic overlap with sedative use. The authors conclude that the findings on novelty-seeking and cannabis use in males may be useful for candidate gene studies. Agrawal, A., Jacobson, K.C., Prescott, C.A., and Kendler K.S. A Twin Study of Personality and Illicit Drug Use and Abuse/Dependence. Twin Research, 7, pp. 72-81, 2004.

Factors Associated with Cessation of Smoking in Young Adults

As part of a longitudinal study of psychopathology and smoking in a school-based sample, 242 daily smokers provided complete data on factors associated with successful smoking cessation. Factors positively associated with successful cessation included being married and having higher household income; those negatively associated included lifetime major depressive disorder, antisocial personality symptoms, family history of drug and alcohol use disorder, and nicotine dependence (for women). In a multivariate analysis, marital status, nicotine dependence (for women), and male gender were significant, and major depression approached significance. Of note, factors associated with successful cessation in young adulthood differed from those predicting smoking initiation and progression; while all Axis I psychiatric diagnoses were associated with uptake and progression, only depression and antisocial behavior had some association (negatively) with cessation in this age group. Thus, factors that predict onset of nicotine use and dependence should not be used to predict cessation, which has implications for intervention programs. Rohde, P., Kahler, C.W., Lewinsohn, P.M., and Brown, R.A. Psychiatric Disorders, Familial Factors, and Cigarette Smoking: III. Associations with Cessation by Young Adulthood Among Daily Smokers. Nicotine & Tobacco Research, 6, pp. 509-522, 2004.

Prevalence, Severity, and Unmet Need for Treatment of Mental Disorders in the World Health Organization World Mental Health Surveys

This study estimated the prevalence, severity, and treatment of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) mental disorders in 14 countries in the World Health Organization (WHO) World Mental Health (WMH) Survey Initiative. Face-to-face household surveys of 60,463 community residents were conducted from 2001-2003 using the WMH version of the WHO Composite International Diagnostic Interview (WMH-CIDI), a fully structured, lay-administered psychiatric diagnostic interview. Results indicate that prevalence of having any disorder in the prior year varied widely, from 4.3% in Shanghai to 26.4% in the United States. Between 33.1% (Colombia) and 80.9% (Nigeria) of 12-month cases were mild. Serious disorders were associated with substantial role disability. Although disorder severity was correlated with probability of treatment in almost all countries, 35.5% to 50.3% of serious cases in developed countries and 76.3% to 85.4% in less-developed countries received no treatment in the 12 months before the interview. Due to the high prevalence of mild and subthreshold cases, the number of those who received treatment far exceeds the number of untreated serious cases in every country. The authors suggest that reallocation of treatment resources could substantially decrease the problem of unmet need for treatment of mental disorders among serious cases, and that careful consideration needs to be given to the value of treating some mild cases, especially those at risk for progressing to more serious disorders. Demyttenaere, K., Bruffaerts, R., Posada-Villa, J., Gasquet, I., Kovess, V., Lepine, J.P., Angermeyer, M.C., Bernert, S., de Girolamo, G., Morosini, P., Polidori, G., Kikkawa, T., Kawakami, N., Ono, Y., Takeshima, T., Uda, H., Karam, E.G., Fayyad, J.A., Karam, A.N., Mneimneh, Z.N., Medina-Mora, M.E., Borges, G., Lara, C., de Graaf, R., Ormel, J., Gureje, O., Shen, Y., Huang, Y., Zhang, M., Alonso, J., Haro, J.M., Vilagut, G., Bromet, E.J., Gluzman, S., Webb, C., Kessler, R.C., Merikangas, K.R., Anthony, J.C., Von Korff, M.R., Wang, P.S., Brugha, T.S., Aguilar-Gaxiola, S., Lee, S., Heeringa, S., Pennell, B.E., Zaslavsky, A.M., Ustun, T.B., Chatterji, S. WHO World Mental Health Survey Consortium. JAMA, 291, pp. 2581-2590, 2004.

Unequal Opportunity: Neighborhood Disadvantage and the Chance to Buy Illegal Drugs

This study investigates whether subgroups of people living in disadvantaged neighborhoods may be more likely to come into contact with drug dealers as compared with persons living in more advantaged areas, with due attention to male-female and race-ethnicity differences. Standardized survey data were collected using stratified, multistage area probability sampling of household residents age 12 or older (N=25,500) living in the United States of America in 1998. Results suggest that women are less likely to be approached by someone selling illegal drugs. The study also found no more than modest and generally null racial and ethnicity differences, even for residents living within socially disadvantaged neighborhoods, where chances to buy illegal drugs are found to be more common. These findings lend support to the inference that physical and social characteristics of a neighborhood can set the stage for opportunities to become involved with drugs. Storr, C.L., Chen, C.Y. and Anthony, J.C. Journal of Epidemiology and Community Health, 58(3), pp. 231-237, 2004.

Neighborhood Environment and Opportunity to Try Methamphetamine ("Ice") and Marijuana: Evidence from Guam in the Western Pacific Region of Micronesia

This study examines the occurrence of youthful drug involvement among youths living in village and metropolitan regions of Guam during 1998. A probability sample of 776 high school students living in Guam, Micronesia, completed a self-report anonymous survey, one that assessed their village and metropolitan neighborhood environments as well as drug involvement. Results indicate that higher levels of neighborhood disadvantage were associated with youths being more likely to have been offered a chance to try drugs. This study adds new evidence on the potential importance of environmental and psychosocial contexts of neighborhood environment that might help account for the nonrandom distribution of youthful drug involvement. Storr, C.L., Arria, A.M., Workman, Z.R. and Anthony, J.C. Substance Use and Misuse, 39(2), pp. 253-276, 2004.

Defining a Never-Smoker Phenotype

The U.S. Centers for Disease Control defines a never-smoker as someone who has smoked <100 cigarettes per lifetime. In an attempt to explore differences among nonsmokers and to validate this cutpoint, this study surveyed 69 nonsmokers who had smoked between 1 and 200 cigarettes in their lifetime on their experiences during the time they smoked. Of the 7 who classified themselves as ex-smokers, 2 met DSM-IV criteria for nicotine dependence, compared with none who classified themselves as never-smokers. No respondents provided data permitting the computation of a Fagerstrom Test for Nicotine Dependence (FTND) score. Withdrawal effects were minimal, but craving, tolerance, and subjective effects showed a pattern of significant differences that were most prominent between those who smoked only 1 cigarette and those who smoked at least a pack. The data indicate a graded effect but also suggest that 19 cigarettes per lifetime is a more conservative cutpoint than 99 for defining the never-smoker phenotype. Further investigation of the smoking trajectory and characteristics associated with development of signs of dependence in never- vs. ever-smokers may help refine this cutpoint and shed light on what protects some people who experiment with smoking from becoming chronic users. Pomerleau, C.S., Pomerleau, O.F., Snedecor, S.M. and Mehringer, A.M. Addictive Behaviors, 29(6), pp. 1149-1154, 2004.

Early Adolescent Through Young Adult Alcohol and Marijuana Use Trajectories

This study takes a developmental approach to subgrouping and examines the trajectories of substance use from early adolescence through young adulthood among a community sample of 481 individuals. The patterns of use were examined, subgroups were identified separately for men and women and for alcohol and marijuana, and psychosocial predictors and psychopathology outcomes that differentiated the groups were identified. The results revealed three substantially overlapping subgroups for both alcohol and marijuana: early onset, late onset, and nonuser. Although the general patterns of which dependent variables were related to group were similar for alcohol and marijuana, a closer examination revealed important subgroup differences. For alcohol use, the early-onset group was more dysfunctional in terms of predictors and outcomes whereas the late-onset and nonuser groups were better adjusted. In contrast, for marijuana, the early- and late-onset groups were both more dysfunctional than the nonuser group. In a final analysis, the researchers examined the predictive utility of our developmental approach to subgrouping compared to a traditional, static approach. Flory, K., Lynam, D., Milich, R., Leukefeld, C., and Clayton, R. Early Adolescent through Young Adult Alcohol and Marijuana Use Trajectories: Early Predictors, Young Adult Outcomes, and Predictive Utility. Development and Psychopathology, 16(1), pp. 193-213, 2004.

Relationship Between Early Experiences with Tobacco and Early Experiences with Alcohol

Prior research indicates that smoking and alcohol use are highly comorbid, animal studies indicate cross-sensitivity, and genetic correlates of nicotine and alcohol dependence overlap. Given these background findings, this study examined the association between retrospectively-reported responses to tobacco and alcohol in current smokers (n=111) and never-smokers (n=86). Results indicated that early smoking experiences were correlated with comparable responses to alcohol in smokers, and to a lesser extent, in never-smokers. Both pleasurable early experiences with nicotine and pleasurable experiences with alcohol predicted current alcohol intake, and pleasurable early experiences with alcohol predicted alcohol dependence. Neither pleasurable nor displeasurable experiences with either substance predicted current amount smoked or degree of nicotine dependence. These preliminary findings may have implications for understanding the mechanisms underlying the smoking-alcohol link. Pomerleau, C.S., Marks, J.L., Pomerleau, O.F. and Snedecor, S.M. Addictive Behaviors, 29(6), pp. 1245-1251, 2004.

Early Childhood Misbehavior and the Estimated Risk of Becoming Tobacco-Dependent

In this study, the authors focused on signs of early childhood misbehavior that might be linked to the risk of becoming tobacco-dependent. Standardized teacher ratings of misbehavior were obtained for an epidemiologic sample of first graders entering an urban mid-Atlantic public school system in 1985 and 1986. Fifteen years later, 1,692 of the students were reassessed (nearly 75% of the original sample). As adults, 962 participants indicated that they had tried tobacco at least once; 66% of the 962 had become daily users. Latent class analysis of items on the Fagerstrom Test for Nicotine Dependence gave evidence of three classes pertinent to tobacco dependence syndrome in smokers by young adulthood: one nondependent class of smokers (50% of smokers), a class of smokers experiencing a moderate number of dependence features (31%), and a third class that was more severely affected (19%), as manifest in the need to smoke immediately after waking and smoking when ill. With or without adjustment for covariates, higher levels of teacher-rated childhood misbehavior at entry into primary school were associated with a modest excess risk of becoming tobacco-dependent by young adulthood (risk ratio = 1.6, 95% confidence interval: 1.1, 2.5). These findings suggest that interventions that seek to improve childhood behavior might reduce early onset tobacco smoking and risk of tobacco dependence among smokers. Storr, C.L., Reboussin, B.A. and Anthony, J.C. American Journal of Epidemiology, 160(2), pp. 126-130, 2004.

Latent Classes of Tobacco Dependence Syndromes Observed in Recent-Onset Tobacco Smokers

This study examined tobacco dependence syndromes that may appear during the first 2 years of tobacco smoking, as such clinical features may provide insights into the transitions that lead from initial smoking toward tobacco dependence. A specific focus was a possible excess risk of tobacco dependence associated with early-onset smoking. Data came from public use files of the 1995-1998 National Household Surveys on Drug Abuse. Analyses were based on responses from 2,993 smokers whose age at onset of tobacco smoking was either equal to the age at the time of the interview (n=1,030) or within 1 year of the age at the interview (n=1,963). Seven clinical features were assessed for a measure of the tobacco dependence syndrome. Findings from latent class analysis best support a model with three classes of smokers; features of tobacco dependence are prominent in just two of these classes, which in aggregate constitute 29% of the recent-onset smokers. Earlier-onset tobacco smokers may have a modestly higher probability of expressing dependence features within 2 years of smoking onset, compared with later-onset smokers (i.e., those starting after age 20). These findings suggest that early-onset smoking may confer modest excess risk of becoming tobacco dependent during the first 2 years after smoking onset. Storr, C.L., Zhou, H., Liang, K-Y. and Anthony, J.C. Nicotine & Tobacco Research, 6(3), pp. 533-545, 2004.

MAOA Haplotypes and Risk for Substance Use Disorders

Monoamine oxidase A (MAOA) locus is an attractive candidate for exploring genetic contribution to the variation in the risk for substance use disorders (SUD) because of its important role in the metabolism of neurotransmitters, including dopamine and serotonin. Prior findings have suggested an association of the MAOA gene with the risk for early onset SUD. To extend this research, this study genotyped four MAOA markers (two VNTR polymorphisms and two SNPs) and built a cladogram reflecting the evolutionary history of MAOA haplotypes (Nguyen et al., under review). The cladogram served as the framework for nested ANOVA and logit analyses of association between MAOA and indices of liability to SUD (diagnosis, age of onset, and a dimensional index of substance use related problems) in a sample of adult males of European ancestry. Whereas no association was found for the categorical diagnosis, a significant relationship was detected between the dimensional liability indices and MAOA haplotypes. These results are consistent with the hypothesis that variants in MAOA account for a small portion of the variance of SUD risk, possibly mediated by liability to early onset behavioral problems. Vanyukov, M.M., Maher, B.S., Devlin, B., Tarter, R.E., Kirillova, G.P., Yu, L.M. and Ferrell, R.E. American Journal of Medical Genetics, 125B(1), pp. 120-125, 2004.

Family Attention and Tobacco Smoking Among Adolescents

This study examined the association between family attention and tobacco use among 5549 adolescent students in five Central American countries, Panama, and the Dominican Republic who participated in a survey of drug use in 1994. Drug use and other variables were assessed using an adapted version of the Drug Use Screening Inventory (DUSI) in Spanish. Students with the highest level of family attention had a lower occurrence of tobacco smoking than students with the lowest level of family attention. Country-specific analyses show similar associations. These findings underscore the need to understand tobacco use in Central America and neighboring countries and to test whether interventions aimed at enhancing parental—child attention, communication, and monitoring reduce the incidence of tobacco use among youths. Gosebruch, G., Sanchez, M., Delva, J., Wagner, F., and Anthony, J.C. Family Attention and Tobacco Smoking Among Adolescents in Central America, Panama, and the Dominican Republic. Substance Use Misuse 38(8), pp. 1037-1106, 2003.

Anxiety and Risk for Substance Use Disorders Among Late Adolescents/Young Adults

This study examined the relation between comorbid and pure (non-comorbid) anxiety disorders and both substance dependence and substance use problems in a community sample of 1,751 young adults ages 18-23. Results indicate that collectively anxiety disorders, both pure and comorbid with other psychiatric diagnoses are predictive of substance dependence. When temporal order was controlled, anxiety disorders generally preceded the onset of substance dependence. However, in analyses in which PTSD was excluded, anxiety disorders were no longer predictive of substance dependence, suggesting that the increased risk associated with anxiety disorders is largely if not wholly attributable to PTSD. Finally, comorbid and pure anxiety disorders were found to be predictive of the number of alcohol and drug use problems. Lopez, B., Turner, R.J., and Saavedra, L.M. Anxiety and Risk for Substance Use Disorders Among Late Adolescents/Young Adults. Journal of Anxiety Disorders. Corrected proof available online 10 May 2004.

Transitions to Drug Use

This study examines whether patterns in the transition from alcohol and tobacco in the Mexican State of Morelos, Mexico are similar to those observed in other countries. The data were from a representative sample of youth age 11-21 (n=13,105), who participated in a paper-and-pencil survey in middle schools, high schools, and colleges in the State of Morelos, Mexico. Drug use was assessed via the standardized instrument most used in Mexican student surveys. Cox's models for discrete-time survival analyses, stratified by school and age group were used to estimate the risk of drug use in relation to early or non early alcohol and tobacco use initiation by gender, while accommodating the complex survey design. The study findings suggest that about five percent of the students were estimated to have used drugs in their life. Male early users of alcohol or tobacco were more likely to use other drugs, compared to students who did not have an early alcohol or tobacco onset. Recommendations for future studies includes an exploration of the role of social mechanisms and their relationship to patterns of drug involvement, even in the context of important differences in rates of drug use. Wagner, F.A., Velasco-Mondrag—n, H.E., Herrera-Vazquez, M., Borges, G. and Lazcano, E. Early Alcohol and Tobacco Use and Transition to Other Drug Use Among Students in the State of Morelos, Mexico. Drug and Alcohol Dependence. Corrected proof available online 24 August 2004.

Relationship of Tobacco Smoking with Depressive Symptomatology

This study aims to estimate the association of depressive symptomatology with tobacco smoking, nicotine dependence, cigarettes smoked daily, and smoking cessation in a representative sample of the Mexican population. A probability sample of 1,935 adults answered a version of the Third National Mexican Addictions Survey that included the CES-D depression scale and specific questions on tobacco use. Analyses addressed the survey's complex design. Active smokers had higher odds of depression than ex-smokers, who had higher odds than non-smokers. Higher levels of tobacco use were more strongly associated with depression as was nicotine dependence in women. Those who ceased smoking recently had lower odds of depression than active smokers. Study findings suggest that smoking cessation interventions should be coupled with attention to depressive symptomatology. Benjet, C., Wagner, F.A., Borges, G., and Medina-Mora M.E. The Relationship of Tobacco Smoking with Depressive Symptomatology in the Third Mexican National Addictions Survey. Psychological Medicine. Published online 18 March 2004.

Correlates of Aggression in African American and Puerto Rican Children

This cross-sectional study examines the interrelationship of psychosocial domains as they relate to aggression in a sample of African American and English-speaking Puerto Rican children living in New York City. The sample included 80 biological children of African American and Puerto Rican young adults who have participated in the authors ongoing longitudinal study and 77 mothers or mother substitutes (rearing mothers) of those children. Hierarchical multiple regression analysis was performed, with childhood aggression as the dependent variable and the following domains as independent variables: child and maternal personality attributes; mother-child relationship; ethnic identification and discrimination; and the partner/marital relationship. The results indicated that: (a) the child's personality and maternal attributes were significantly related to the child's aggression, despite control on all the other domains; (b) the ethnic identification and discrimination domain was no longer related to the child's aggression with control on the mother-child relationship domain or the child's personality domain. The findings have implications for clinical practice and public policy, and provide significant insights into childhood risk factors that need to be altered to reduce physical aggression. Brook, J.S., Rosenberg, G., Brook, D.W., Balka, E.B. and Meade, M. Correlates of Aggression in African American and Puerto Rican Children. Journal of Genetic Psychology, 165(2), pp. 185-202, 2004.

Illicit Drug Use and Risky Sexual Behavior Among African American and Puerto Rican Urban Adolescents: The Longitudinal Links

This study assessed whether (a) early illicit drug use predicts later risky sexual activity; (b) early risky sex predicts later illicit drug use; and (c) common factors affect both risky sex and illicit drug use. African American and Puerto Rican youth completed questionnaires in their classrooms at Time 1 (T1) and face-to-face interviews five years later at Time 2 (T2). Logistic regression analyses showed the association between T1 illicit drug use and T2 risky sexual activity and between T1 risky sexual behavior and T2 illicit drug use. With few exceptions, T1 illicit drug use was associated with all of the T2 risky sexual behaviors. After controlling for demographic factors, multiple sex partners at T1 was not related to illicit drug use at T2. Condom use at T1 was related to illicit drug use at T2, whereas sexually transmitted diseases and early pregnancy were not. The findings indicated that assessments of and treatments for substance use should focus on the risky sexual behaviors that seem to accompany illicit drug use. Brook, J.S., Adams, R.E., Balka, E.B., Whiteman, M., Zhang, C. and Sugerman, R. Illicit Drug Use and Risky Sexual Behavior Among African American and Puerto Rican Urban Adolescents: The Longitudinal Links. Journal of Genetic Psychology, 165(2), pp. 203-220, 2004.

Risk-Taking Behaviors Among African American Adolescents

This study explores the relationship between peer status, peer groups' social influence and risk-taking behavior in an urban sample of 647 African American seventh grade students. Highest rates of problem behaviors were seen in those youth who were both highly liked and highly disliked by other youth. Findings also revealed contrasting patterns of peer group leadership. The more controversial the youth the more likely the involvement in deviant peer groups. Results highlight the importance of controversial status students as key influence agents during early adolescence, and implications for prevention interventions to reduce adolescent problem behaviors. Miller-Johnson, S., Costanzo, P.R., Cole, J.D., Rose, M.R., Browne, D.C., and Johnson, C. Peer Social Structure and Risk-Taking Behaviors Among African American Early Adolescents. Journal of Youth and Adolescence, 32(5), pp. 375-384, 2003.

Drug Use Among American Indian Adolescents

This study examines the trends in drug use among American Indian adolescents attending school on or near the Indian reservations in the United States. The study provides comparisons between American Indian and non-Indian youth to assess their drug use and issues of prevention. Reliable and valid school administered surveys have been given every year for 25 years (1975 — 2000) to representative samples of American Indian youth living on reservations, providing a continuous record of drug use. Comparisons are made with non-Indian youth with data from the Monitoring the Future project. From 1975 to 2000, reservation Indian youth show elevated levels of drug use for most illicit drugs compared with non Indian youth. Despite higher levels of use, the trends showing increases and decreases in use over time mirror that by non-Indian youth. Indian youth who use drugs can be divided into two groups, moderate category and high levels of use. The number of youth in the moderate category vary overtime, whereas the number in the high level category are relatively constant. There is a clear need for intensive efforts to reduce the levels of drug use among Indian youth, however future interventions must address the differing characteristics of high and moderate risk users of drugs. Beauvais, F., Jumper-Thurman, P., Helm, H., Plested, B. and Burnside, M. Surveillance of Drug Use Among American Indian Adolescents: Patterns Over 25 Years. Journal of Adolescent Health, 34, pp. 493-500, 2004.

Sources of Information about MDMA/Ecstasy

Researchers conducted a cross-sectional study to assess the perceived accuracy and importance of various sources of information about MDMA/ecstasy among young adult users. They used a respondent driven sampling plan to recruit and then interview recent ecstasy users (n = 304), aged 18-30, in Ohio. Information collected included the most common venue of ecstasy use; the total number of occasions ecstasy had been used; behavioral intentions to use ecstasy again; and the perceived accuracy as well as the importance of 16 sources of information about ecstasy, including the Internet. Friends, drug abuse treatment programs, and physicians were identified as the most accurate sources of information about ecstasy by 45.7%, 37.2%, and 30.3% of the sample, respectively. Friends were considered the most important source of information about ecstasy (40.2%), followed by web sites like DanceSafe (16.2%), and MTV/VH1 television specials (6.9%). More than half the sample used the Internet to obtain information about ecstasy, with younger and more educated participants significantly more likely to do so. Educated users were also significantly more likely to consider the Internet to be an important source of information, and visited sites like DanceSafe as many as 4 times more often than government-sponsored web sites. These findings support the development of peer-oriented, network strategies to reach ecstasy users with prevention messages. In particular, efforts should be made to make prevention information web sites more attractive and useful. Falck, R.S., Carlson, R.G., Wang, J. and Siegal, H.A. Sources of Information about MDMA/Ecstasy: Perceived Accuracy, Importance, and Implications for Prevention Among Young Adult Users. Drug and Alcohol Depend, 74, pp. 45-54, 2004.